| NPI | 1255676300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 8295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8295) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2020-01-23 |